Transforming a Home Into a Therapeutic Environment

Posted on January 11th, 2014 by Denise | No Comments

Transforming a Home Into a Therapeutic Environment


Denise Koonce OTR

A couple of months ago I wrote a blog regarding the benefits and joys of pediatric home health, so today I thought I might follow up that blog with some functional information on how to transform a patient’s home into a therapeutic environment.  Every home is different, as is the family and patient that reside there.  Each patient comes with a different personality, different way of accepting new information and adaptation, as well as how they act, react, and interact.  So how do you set up a home environment to best provide the necessary intervention for progress?  Be creative!  Therapists who treat in a home setting typically use their car as a virtual office.  It serves as your transportation, of course, but also your office.  You have paper work, phone, computer, lunch, map or nowadays a navigation system, cleaning supplies and you have toys, lots of toys.  Big toys, little toys, toys for gross, fine, sensory, visual, verbal, and oral motor play.  At times there might also be a bench, ball, and mat in the car.  The goal is to be prepared and try to offer anything necessary to help your patient gain the developmental skills necessary for daily life.  However, there is only so much space in a car and that’s where your creativity in the adaptive use of your surrounding environment comes into play.  Here are some suggestions you may find useful when treating in pediatric home health:

I also want to preface with these suggestions that you should also always ask permission from the parent or caregiver prior to trying them.

Couch – couches can be a very diverse tool.  They tend to be a great height for toddlers who need to work on gross motor activities such as pull to stand, sit to stand, trunk control with and without rotation, reaching and grasping with dynamic gross motor function, etc.  Therefore, by you on the floor and the couch as your treatment environment, a multitude of possibilities is available.  If you remove some of the couch cushions and place them on the floor, you can set up a great gross motor obstacle course.  The cushions also serve as a wonderful dynamic balance tool and surface.

Bathtubs/showers – they are great for messy sensory play as are high chair trays and certain kitchen tables.  In addition, I would use disposable tablecloths as well as the vinyl topped, cotton backed, picnic tablecloths to use for messy play.  I would place the table cloth either on the floor or table and when we were done with messy play just fold it up and throw it away or hose it off.  The table clothes provided a large surface to work from and peace of mind regarding a mess.

Backyard or neighborhood play equipment – utilize the swings, climbing equipment, slides, sand boxes, trampolines, etc. when available.  If none of these are available and you want to provide vestibular input add a 7- 8 foot sheet of Lycra, in length, to your “bag of tricks”.  It can be purchased at fabric stores and the bolt width it comes in is usually about 4-5 feet.  Tie each end in a double knot and then place one knotted end on the opposite side of a bolted door, and bolt close.  Place the child inside the hammock style swing and pick up the opposite knotted end and begin to swing or bounce; instant indoor swing.

Household step stools – these make good benches or depending on riser height they are good for working on hip disassociation.  They can also be used as an introduction to stairs if there are no other stairs present in the environment.

Towels/blankets/pillows – these can be rolled to various diameters and set in place with rubber bands.  They can be used as bolsters, back rolls, arms rolls and blocks.

Utilize the toys already present in the child’s home.  Take an inventory of what they have and what their favorite items are and incorporate them into your treatment session.   I also kept some traditionally non therapy items in my car to help create the environment I needed in the home.  Some of these items were clothes pins or food clips, safety pins, quart and gallon size baggies, rubber bands of all sizes, empty water bottles, string or small rope, an old sheet, twist ties, and duct tape to name a few.

The benefits of providing therapy services within a child’s own environment can be very powerful and advantageous.  However, the environment can appear limiting if you do not fully utilize what it has to offer.  Be creative and think outside the box.  If you have some favorite home environment adaptations please share them with us and explain how you have used them.

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